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Extending Independent Nurse Prescribing within NHSScotland
ANNEX C
NHS EDUCATION FOR SCOTLAND OUTLINE CURRICULUM FOR THE PREPARATION OF NURSES, MIDWIVES AND HEALTH VISITORS TO PRESCRIBE FROM THE EXTENDED NURSE PRESCRIBERS' FORMULARY
This outline curriculum is separate from the preparation of district nurses and health visitors who prescribe from the Nurse Prescribers' Formulary.
ENTRY REQUIREMENTS
All entrants to this education programme must meet the following requirements:
valid registration on Part 1, 3, 5, 8, 10, 11, 12, 13, 14 or 15 of the Professional Register maintained by the Nursing and Midwifery Council;
have appropriate experience in the area of practice in which they will be prescribing;
demonstrate an ability to study at academic SD Level 3;
have support from the employing organisation;
have a designated and qualified prescribing practitioner* who will provide the student with supervision, support and opportunities to develop competence in prescribing practice. (This includes shadowing opportunities.)
*This will be a medical practitioner at present.
District nurses and health visitors who prescribe from the Nurse Prescribers' Formulary, and who, with local agreement, will extend their prescribing responsibilities under new arrangements from 2002, must complete this programme of preparation and meet the assessment requirements. It is expected that there will be recognition of prior learning and experience, where appropriate, to avoid duplication of learning.
AIM
The education programme is to prepare nurses, midwives and health visitors to prescribe from the Extended Nurse Prescribers' Formulary as Independent Prescribers.
LEARNING OUTCOMES
The learning outcomes of the programme are at Level 3 and will enable the practitioner to:
assess and consult with patients and carers;
prescribe safely, appropriately and cost-effectively;
apply the legislation relevant to the practice of nurse prescribing;
use sources of information, advice and decision support appropriately in prescribing practice;
critically evaluate the influences on prescribing practice;
apply knowledge of medications in prescribing practice;
demonstrate cognisance of the teamwork and communication networks involved in prescribing, supplying and administering medicines;
practice within a framework of professional accountability and responsibility in relation to nurse prescribing.
INDICATIVE CONTENT
In order to meet the learning outcomes, it is expected that curriculum planning teams will include the following areas of study and develop these into a detailed curriculum, which will enable practitioners to develop knowledge and competence as prescribers.
Consultation, Decision-making and Therapy including Referral
models of consultation
accurate assessment, communication and consultation with patients and their carers
concepts of working diagnosis or best formulation
development of a management plan
confirmation of diagnosis - further examination, investigation, referral for diagnosis
prescribe, not to prescribe, non-drug treatment or referral for treatment
Influences on and Psychology of Prescribing
patient demand versus patient need
external influences, for example companies/colleagues
patient partnership in medicine-taking including awareness of cultural and ethnic needs
conformance - normalisation of professional prescribing behaviour
achieving shared understanding and negotiating a plan of action
Prescribing in a Team Context
national and local guidelines, protocols, policies, organisations, decision support systems and formulae - rationale, adherence to and deviation from
understand the role and functions of other team members
documentation, with particular reference to communication between team members including electronic prescribing and access to electronic patient records
auditing, monitoring and evaluating prescribing practice
interface between multiple prescribers and the management of potential conflict
budget/cost effectiveness
issues relating to dispensing practices
Clinical Pharmacology including the Effects of Co-morbidity
pharmacology including pharmacodynamics and pharmacokinetics
anatomy and physiology as applied to prescribing practice
basic principles of drugs to be prescribed - absorption, distribution, metabolism and excretion including adverse drug reactions (ADR), interactions and reactions
patient compliance and drug response
impact of physiological state in, for example the elderly, young, pregnant or breast-feeding women, on drug responses and safety
EVIDENCE-BASED PRACTICE AND CLINICAL GOVERNANCE IN RELATION TO NURSE PRESCRIBING
national and local guidelines, protocols, policies, organisations, decision support systems and formulae - rationale, adherence to and deviation from
continuing professional development - role of self and organisation
management of change
risk assessment and risk management, including safe storage, handling and disposal
clinical supervision
reflective practice
critical appraisal skills
auditing and systems monitoring
identifying and reporting ADRs and near misses
Legal, Policy and Ethical Aspects
legal basis, liability and indemnity
legal implications of advice to self-medicate including the use of complementary therapy and 'over the counter' (OTC) medicines
safe keeping of prescription pads, action if lost, writing prescriptions and record keeping
awareness and reporting of fraud
drug licensing
yellow card reporting to the Committee on Safety on Medicines (CSM)
prescribing in the policy context
manufacturers' guidance relating to literature, licensing and 'off-label'
ethical basis of intervention
informed consent, with particular reference to client groups in learning disability, mental health, children, the critically ill and emergency situations
Professional Accountability and Responsibility
NMC Code of Professional Conduct and Scope of Professional Practice
accountability and responsibility for assessment, diagnosis, prescribing and over-the-counter medicines, etc.
maintaining professional knowledge and competence in relation to prescribing
accountability and responsibility to the employer
Prescribing in the Public Health Context
duty to patients and society
policies regarding the use of antibiotics and vaccines
inappropriate use of medication including misuse, under- and over-use
inappropriate prescribing, over- and under-prescribing
access to health care provisions and medicines
TEACHING, LEARNING AND PRACTICE SUPPORT STRATEGIES
It must be emphasised that self-directed learning and critical reflection are important component parts of the education process. The use of a portfolio or learning log as an effective means of facilitating and recording the student's critical thinking and reflecting is well established in professional education.
In addition, the use of random case analysis allows in-depth analysis of treatment scenarios where patient care and prescribing behaviour could be further examined and reflected upon. This approach also provides meaningful feedback to the student, the practice supporter and higher education.
NES therefore expects these learning approaches to be used in the preparation of nurse prescribers.
The approved higher education institution must ensure that the designated prescribing practitioner who provides supervision, support and shadowing opportunities for the student is familiar with the requirements of the programme and in particular the achievement of the learning outcomes.
ASSESSMENT STRATEGIES
Competence will be demonstrated through an assessment of theory and practice. To facilitate this each student will maintain a portfolio of assessment and achievement of the stated learning outcomes.
The assessment requirements must be made explicit, in particular the criteria for pass/fail and the details of the marking scheme.
A range of assessment strategies will be employed to test knowledge, decision-making and the application of theory to practice. These may include:
(a) review of portfolio or learning log
(b) Objective Structured Clinical Examination (OSCE), a systematic and detailed examination of practice within a simulated learning environment such as a skills laboratory/centre
(c) satisfactory completion of the period of practice experience*
(d) written final examination consisting of:
(i) multiple choice questions (MCQ)/short-answer questions - testing knowledge and application
(ii) essay - testing decision-making and prescribing behaviour
* The assessment of practice will be the responsibility of the qualified prescribing practitioner providing support, teaching and supervision of the student. Initially this will be a medical practitioner but in future it is envisaged that nurse prescribers may carry out this function.
LENGTH OF THE PROGRAMME
The programme should be 25 days or equivalent for the theory component, over a minimum period of 3 months. Alongside the theory component, students are expected to shadow their prescribing practitioner for the equivalent of one day per week of educationally led practice (12 days in total). The total length of the programme is therefore approximately 37 days or equivalent.
It is anticipated that the programme will attract approximately 20 academic credits at Level 3.
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